Word choice and verbal instruction impacts how one performs a pelvic floor muscle contraction. Previous research on women suggests that around 40% of women do not perform a kegel or pelvic floor muscle contraction correctly with verbal instruction and 25% of them were doing something that would increase the likelihood of leaking such as holding their breath. Research from Stafford et al. in 2016, studied 15 healthy men without pelvic floor dysfunction using transperineal ultrasound imaging and surface EMG electrodes for biofeedback. The researchers looked at a variety of verbal cues, traditionally used in therapy, to see which produced the most specific pelvic floor muscle contractions. The specific cues studied were: “tighten around the anus,” “elevate the bladder,” “shorten the penis,” and “stop the flow of urine”.  

The researchers found that “stop the flow of urine and shorten the penis” produced the most mid-urethra activity including the anterior pelvic floor muscles in charge of urine control and similar muscles that are acutely responsible for obtaining and maintaining an erection. “Tighten the anus” recruited more anal sphincter activity or posterior pelvic floor muscles, used for stool and gas control. The cue to “elevate the bladder” was the least effective, creating increased abdominal muscle use and increased intra-abdominal pressure. It is also important to cue “continue to breath and avoid tensing abdominals”.

This research demonstrates the importance of specific cueing and an individualized exercise program to address the specific needs of each patient. One size does not fit all in regards to treating urinary, bowel, or erectile dysfunction. If you are struggling with urinary incontinence, frequency, constipation, stool incontinence or erectile dysfunction make an appointment with a pelvic floor specialist today to see if you would benefit from pelvic floor muscle coordination training and which cues work best for you.

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